This study developed an animal model with internal and external urethral sphincter insufficiency by bypassing the sphincter without major damage so that the animal under study can return to normal life after the study...This study developed an animal model with internal and external urethral sphincter insufficiency by bypassing the sphincter without major damage so that the animal under study can return to normal life after the study.There is a need for a reliable,applicable,and reproducible animal model for studying urinary incontinency disease due to incorrect sphincter function.Seven adult male dogs were used for this study.The urethral sphincter was bypassed by inserting a catheter between the bladder neck and the distal sphincter.The animals'physical condition was closely monitored for 9 weeks,and standard urodynamic and radiologic studies were performed before and 1–2 months after surgery.The animals were killed at 9 weeks after surgery for pathological assessment.Catheter placement caused complete incontinence in the animal,with urodynamic assessments indicating that the animal was unable to control urination and radiological assessments indicating an empty bladder with a residual volume of 50±10 cc.Tissue analysis did not show significant histological damage and inflammation.The study shows that by bypassing the urethral sphincter,which is a reliable and reproducible method,an animal model of urinary incontinence can be developed,which can be used in various studies such as assessing the adequacy of artificial sphincter function.The animals under study did not have any permanent defect,so they were able to return to their normal life.展开更多
Objectives:Pelvic fracture urethral injuries(PFUI)result from traumatic disruption of the urethra.A significant proportion of cases are complex rendering their management challenging.We described management strategies...Objectives:Pelvic fracture urethral injuries(PFUI)result from traumatic disruption of the urethra.A significant proportion of cases are complex rendering their management challenging.We described management strategies for eight different complex PFUI scenarios.Methods:Our centre is a tertiary referral centre for complex PFUI cases.We maintain a prospective database(1995e2016),which we retrospectively analysed.All patients with PFUI managed at our institute were included.Results:Over two decades 1062 cases of PFUI were managed at our institute(521 primary and 541 redo cases).Most redo cases were referred to us from other centres.Redo cases had up to five prior attempts at urethroplasty.We managed complex cases,which included bulbar ischemia,young boys and girls with PFUI,PFUI with double block,concomitant PFUI and iatrogenic anterior urethral strictures.Bulbar ischemia merits substitution urethroplasty,most commonly,using pedicled preputial tube.PFUI in young girls is usually associated with urethrovaginal fistula.Young boys with PFUI commonly have a long gap necessitating trans-abdominal approach.Our success rate with individualised management is 85.60%in primary cases,79.13%in redo cases and 82.40%in cases of bulbar ischemia.Conclusion:The definition of complex PFUI is ever expanding.The best chance of success is at the first attempt.Anastomotic urethroplasty for PFUI should be performed in experienced hands at high volume centres.展开更多
Objective:The management of urethral stricture disease depends on the location,length of stricture,and associated urethral pathology.These parameters are obtained from preoperative imaging,with conventional urethrogra...Objective:The management of urethral stricture disease depends on the location,length of stricture,and associated urethral pathology.These parameters are obtained from preoperative imaging,with conventional urethrogram(retrograde urethrogram and micturating cystourethrogram[RGU/MCU])being the diagnostic tool of choice despite its many shortcomings.Sono-urethrogram(SUG)is an alternative that addresses most issues of RGU/MCU.Studies comparing RGU/MCU with SUG are limited.With the objective of comparing these two imaging modalities in the evaluation of urethral stricture disease,a prospective study was conducted.Methods:Fifty-six patients suspected of urethral stricture disease on clinical evaluation and confirmed either on RGU/MCU or urethro-cystoscopy were included in the study.SUG was performed by the experienced consultant radiologist who was blinded to the report of RGU/MCU.Findings of RGU/MCU and SUG were compared to intraoperative findings,which served as the reference standard.Results:The median length of the stricture determined intraoperatively was 16.5 mm,by RGU/MCU was 5.8 mm,and by SUG was 13.5 mm.The diagnostic accuracy for determination of the stricture location was 93%for RGU/MCU and 98%for SUG.SUG identified spongiofibrosis in 90%of patients with higher accuracy for the severe degree of spongiofibrosis.Conclusion:SUG has been shown to be more accurate than RGU/MCU in estimating stricture length(both short and intermediate)and localizing the stricture location.Use of SUG in conjunction with RGU/MCU helps in better guidance of stricture management by improving preoperative assessment.Further studies with larger sample sizes are warranted.展开更多
Urethral catheterization is an important skill to develop as consultations for“difficult catheterization”are common in practice.Developing a broad approach to difficult urethral catheterization is crucial to improve...Urethral catheterization is an important skill to develop as consultations for“difficult catheterization”are common in practice.Developing a broad approach to difficult urethral catheterization is crucial to improve trainee success rates.Strategies and techniques to improve catheterization success are often passed down and shared between trainees without formal documentation or dissemination of techniques.Herein,we present a framework for difficult urethral catheterization based on clinical history and patient examination,while also providing additional techniques and troubleshooting to overcome common challenges with urethral catheterization in adult and pediatric patients.展开更多
We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to perman...We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to permanent severe stress incontinence.In February 2023,he presented with a painless cystic mass in the scrotum.Upon pressing the mass with hand,fluid drained from the external urethral orifice,causing the mass to shrink in size,although it returned to its original size a few hours later.Urography and cystoscopy showed a globular urethral diverticulum located anteriorly.The patient underwent surgical excision of the diverticulum along with urethroplasty.Postoperatively,the urinary stress incontinence persisted,but he declined any further surgical intervention.An artificial urinary sphincter is currently the first-line treatment for male urinary incontinence.However,devices such as penile clamps can serve as an alternative when considering surgical suitability or cost.It is important to note that these devices can lead to serious complications such as urethral erosion,stricture,or diverticulum.Therefore,caution is advised when using such devices,and they should be removed periodically at short intervals.展开更多
Background:Bladder augmentation is often necessary to address poorly compliant and low-capacity bladders which can result from Posterior Urethral Valve.Traditional techniques are limited by complications from using bo...Background:Bladder augmentation is often necessary to address poorly compliant and low-capacity bladders which can result from Posterior Urethral Valve.Traditional techniques are limited by complications from using bowel tissue,thus in the setting of a megaureter,ureterocystoplasty is favorable.Methods:We present a case of Teapot ureterocystoplasty,which improves vascular protection of the ureter by leaving the distal 3 cm of the ureter tubularized.Cystograms demonstrated bladder capacity improvement from 50 mL to 180 mL post-operatively.Additionally,Creatinine stabilized after a peak of 250 umol/L.Result and Conclusion:This patient is doing well at 4.5-year surveillance and has avoided renal transplant,a common fate for these children.展开更多
Lower urinary tract symptoms(LUTS)in women produce significant bother.Common conditions causing LUTS in women include urinary tract infections,overactive bladder,and stress incontinence.Urethral diverticulae and femal...Lower urinary tract symptoms(LUTS)in women produce significant bother.Common conditions causing LUTS in women include urinary tract infections,overactive bladder,and stress incontinence.Urethral diverticulae and female urethral strictures are rare pathologies.They can cause symptoms,which can mimic commoner conditions,leading to delay in diagnosis and unnecessary delay in treatment.In this article,we discuss in detail the definition,symptoms,epidemiology,pathogenesis,diagnosis,and treatment option for these two conditions.Further understanding of these conditions will aid in the proper diagnosis and prevent delay in management.展开更多
The treatment of urethral strictures remains a challenging field in urology even though there are a variety of procedures to treat it at present,as no one approach is superior over another.This paper reviewed the surg...The treatment of urethral strictures remains a challenging field in urology even though there are a variety of procedures to treat it at present,as no one approach is superior over another.This paper reviewed the surgical options for the management of different sites and types of anterior urethral stricture,providing a brief discussion of the controversies regarding this issue and suggesting possible future advancements.Among the existing procedures,simple dilation and direct vision internal urethrotomy are more commonly used for short urethral strictures(<1 cm,soft and no previous intervention).Currently,urethroplasty using buccal mucosa or penile skin is the most widely adopted clinical techniques and have proved successful.Nonetheless,complications such as donor site morbidity remain problem.Tissue engineering techniques are considered as a promising solution for urethral reconstruction,but require further investigation,as does stem cell therapy.展开更多
Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retro...Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.展开更多
Objective Incidences of post-transurethral resection of the prostate(post-TURP)strictures are between 2.2%and 9.8%.Stricture commonly occurs within the first 6 months.Our objective was to assess the outcomes of patien...Objective Incidences of post-transurethral resection of the prostate(post-TURP)strictures are between 2.2%and 9.8%.Stricture commonly occurs within the first 6 months.Our objective was to assess the outcomes of patients with obliterative strictures post-TURP that underwent a double-face urethroplasty.Methods This is a single-center prospective study of 17 patients with obliterative proximal bulbar stricture post-TURP who underwent double-face graft urethroplasty by two surgeons between January 2014 and January 2020.We defined post-TURP obliterative strictures as those patients who presented with complete or almost complete obstruction of the urethral lumen and who have had a history of acute urine retention.We have excluded patients with bladder neck contracture.Primary outcome was treatment success,defined as the no need for further treatments.Secondary outcome was post-urethroplasty continent rate.Results Seventeen patients were included in the study with median age of 66(interquartile range 40-77)years;median time of follow-up was 24(interquartile range 12-84)months;median stricture length was 4(interquartile range 2-6)cm.Of the 17 patients,15(88.2%)were successful.All patients were continent after urethroplasty.Conclusion With mid-term follow-up,treatment of obliterative proximal bulbar strictures with double-face buccal mucosa graft is a safe and effective procedure.Obliterative proximal bulbar strictures merit double-face urethroplasty with high-rate success and functional outcomes.展开更多
For more than nine decades,transurethral resection of the prostate remains the gold standard for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction.The occurrence of urethral st...For more than nine decades,transurethral resection of the prostate remains the gold standard for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction.The occurrence of urethral strictures after transurethral resection of the prostate is one of the major late complications and has been reported as the leading cause of iatrogenic urethral strictures in patients older than 45 years who underwent urethroplasty.Although several postulations have been proposed to explain the urethral stricture after transurethral resection of the prostate,the exact etiology of urethral stricture after TURP is still controversial.Suggested etiological factors of urethral stricture formation after transurethral resection of the prostate include infection,mechanical trauma,prolonged indwelling catheter time,use of local anesthesia,and electrical injury by a stray current.One single treatment option is not appropriate for all stricture types.The management of urethral stricture following transurethral resection of the prostate includes minimally invasive endoscopic methods,including urethral dilation and direct visual incision,or open surgical procedures with varying urethroplasty techniques.Although scientific studies focusing on urethral strictures after transurethral resection of the prostate are relatively limited and sparse,we can apply the principles of urethral stricture management before making decisions on individual stricture treatment.展开更多
Advances in urogenital plastic surgical tissue transfer techniques have enabled urethral reconstruction surgery to become the new gold-standard for treatment of refractory urethral stricture disease. Questions remain,...Advances in urogenital plastic surgical tissue transfer techniques have enabled urethral reconstruction surgery to become the new gold-standard for treatment of refractory urethral stricture disease. Questions remain, however, regarding the long-term implications on sexual function after major genital reconstructive surgery. In this article, we review the pathologic features of urethral stricture disease and urologic trauma that may affect erectile function （EF） and assess the impact of various specific contemporary urethroplasty surgical techniques on male sexual function.展开更多
The aim of this study was to evaluate erectile function in patients with panurethral stricture after urethral reconstruction. Totally, 65 patients were enrolled. Different urethral reconstructions were performed accor...The aim of this study was to evaluate erectile function in patients with panurethral stricture after urethral reconstruction. Totally, 65 patients were enrolled. Different urethral reconstructions were performed according to the details of urethral strictures. The erectile function was evaluated before and after surgery. The length and location of stricture and duration from initial diagnosis to operation were recorded. The International Index of Erectile Function-5 （IIEF-5） scores, the quality of life （QoL） scores and the maximal flow rate were obtained before and 3, 6, and 12 months after surgery. A significant improvement in QoL and maximal flow rate was observed 3, 6, and 12 months after surgery compared with those observed before surgery （P 〈 0.05）. An impairment of erectile function was observed in patients with multi-site stricture 3 months after surgery （P 〈 0.05）. Subsequently, these patients recovered 6 and 12 months after surgery. Three months after surgery, the IIEF-5 scores in patients with anterior urethral stricture were higher than those with multi-site stricture. Similar results were observed 6 and 12 months after surgery. No significant difference in age or duration from initial diagnosis to final operation was observed between patients with erectile dysfunction after surgery and patients with normal erectile function. However, a linear regressive relationship was detected between IIEF-5 scores and location of urethral stricture. Surgical reconstruction for treating panurethral strictures has limited effects on erectile function. The location of the stricture, particularly when extended to posterior urethra, was found to be associated with erectile function after surgery.展开更多
The recent International Consultation on Urological Disease(ICUD)panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis,as distinct from sphin...The recent International Consultation on Urological Disease(ICUD)panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis,as distinct from sphincter stenoses and a urethral disruption injury.Whenever possible,an anastomotic urethroplasty should be performed because of the higher success rate as compared to augmentation urethroplasty.There is some debate currently regarding the critical stricture length at which an anastomotic procedure can be used,but clearly the extent of the spongiofibrosis and individual anatomical factors(the length of the penis and urethra)are important,the limitation for this being extension of dissection beyond the peno-scrotal junction and the subsequent production of chordee.More recently,there has been interest in whether to excise and anastomose or to carry out a stricturotomy and reanastomosis using a Heineke-Miculicz technique.Augmentation urethroplasty has evolved towards the more extensive use of oral mucosa grafts as compared to penile skin flaps,as both flaps and grafts have similar efficacy and certainly the use of either dorsal or ventral positioning seems to provide comparable results.It is important that the reconstructive surgeon is well versed in the full range of available repair techniques,as no single method is suitable for all cases and will enable the management of any unexpected anatomical findings discovered intra-operatively.展开更多
Objective To assess the therapeutic efficiency of short anterior urethral stricture treated with endourethral surgery combined with iridium 192 radiation therapy in order to decrease the recurrence rate after endouret...Objective To assess the therapeutic efficiency of short anterior urethral stricture treated with endourethral surgery combined with iridium 192 radiation therapy in order to decrease the recurrence rate after endourethral surgery.Methods A total of 286 patients with anterior urethral stricture(stricture length ranging from 0.5 to 2.5 cm,averaging at 1.6 cm)were divided randomly into two groups after internal urethrotomy and cicatrix electrotomy.The radiation group of 173 patients was treated as soon as possible with iridium 192 radiation therapy on the stricture sections while the control group of 113 patients was not.The recurrence rate was compared between the two groups during one year’s follow-up.Results Among all the 286 successful operations,stricture recurred in 19 patients of the radiation group(recurrence rate of 10.98%)and in 62 ones of the control group(recurrence rate of 54.86%),with a significant difference(P=0.003).Conclusion It is an effective way to prevent recurrence by treating patients as early as possible with iridium 192 radiation on the stricture sections after endourethral operation on anterior urethral stricture.展开更多
Objective:To investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate(TURP)and correlate its incidence with intra-operative urethral mucosal injury during T...Objective:To investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate(TURP)and correlate its incidence with intra-operative urethral mucosal injury during TURP.Also to compare the other established risk factors affecting the development of urethral stricture among patients undergoing monopolar or bipolar TURP over a period of 6 months follow-up as the prospective randomized study.Methods:One hundred and fifty men older than 50 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo either standard monopolar TURP with glycine as the irrigation fluid or bipolar TURP with normal saline as irrigant.The prostate size,operative time,intra-operative mucosal rupture,catheter time,catheter traction duration,uroflowmetry,and post-operative stricture rate were compared.Results:A total of 150 patients underwent TURP,including 74 patients undergoing monopolar TURP(one patient was excluded as his post-operative histopathological examination report was of adenocarcinoma prostate)and 75 patients undergoing bipolar-TURP,all of which were performed using a 26 Fr sheath resectoscope.The mean International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 months and 6 months were comparable between the groups.Out of 149 patients,nine patients(6.0%)developed urethral stricture.The severity of the injury(urethral mucosal injury)correlated with the likelihood of developing a subsequent complication(stricture urethra).Patients with stricture had significantly larger prostate volume than patients without stricture(65.0 mL vs.50.0 mL;p=0.030).Patients with stricture had longer operative time than patients without stricture(55.0 min vs.40.0 min;p=0.002).In both procedures,formation of post-operative stricture urethra was independently associated with intra-operative mucosal injury.Conclusion:Intra-operative recognition of urethral mucosal injury helps in prediction of stricture urethra formation in early post-operative period.展开更多
AIM： To analyze the clinical features, diagnostic modalities, and the surgical management of urethral complications after tension-free vaginal tape procedures.METHODS： This study encompasses a retrospective review o...AIM： To analyze the clinical features, diagnostic modalities, and the surgical management of urethral complications after tension-free vaginal tape procedures.METHODS： This study encompasses a retrospective review of nine patients presented with urethral complic-ations after midurethral sling procedures. The patients underwent the procedures during a period from 1999 to 2012 in three different regional hospitals in the southwest part of Sweden. The time from sling placement to diagnosis, the risk factors, clinical features, diagnosis, surgical management, and functional outcome are presented. The presenting symptoms were described as either early onset （〈 12 mo） or late onset （〉 12 mo） according to when they were frst reported.RESulTS： Eight cases of urethral erosion and one case of bladder-neck erosion were detected. The mean interval for diagnoses of the erosions ranged from 3 mo to 11 years. The most common presenting symptoms included de novo urgency with or without incontinence （7/9 patients）, urinary retention/voiding dysfunction （4/9 patients）, urethritis （4/9 patients）, relapse of stress-incontinence （3/9 patients）, recurrent urinary tract infections （5/9 patients）, and hematuria （1/9 patient）. In most cases, voiding dysfunction and urethritis occurred early after the operation. The surgical management applied in most cases was transurethral resection of the intraurethral part of the mesh. The removal of the intraurethral mesh resulted in improvement or complete cure of urgency symptoms in 5/7 patients with urgency. Four patients were reoperated with a new stress-incontinence surgery, one with laparoscopic Burch, and three with retropubic tension-free vaginal tape procedures. COnCluSIOn： Urethral complications should be suspected in the case of de novo urgency and relapse of stress-incontinence. Transurethral excision of the intraurethral mesh is the recommended treatment.展开更多
Objectives: To report the 2-years follow-up of patients with bulbar urethral strictures treated with the new AlliumTM Bulbar Urethral Stent (Allium BUS). Methods: The stent is a fully covered, self-expendable, large c...Objectives: To report the 2-years follow-up of patients with bulbar urethral strictures treated with the new AlliumTM Bulbar Urethral Stent (Allium BUS). Methods: The stent is a fully covered, self-expendable, large caliber metal stent specially designed for the treatment of bulbar urethral strictures. The stent is comprised of a coiled super-elastic structure covered by a polymeric coating designed to prevent mucosal hyperplasia. The indwelling time is 12 months, after which the stent should have been removed. Sixty-four patients with recurrent bulbar stricture were treated with Allium BUS in 3 worldwide centers. Results: All stents were successfully inserted with no perioperative complications. In a median follow-up of 25.5 months, the mean maximal flow rate following stent insertion was significantly higher compared to the pre-surgical flow rate (14 ml/sec vs 6.6 ml/sec, p < 0.0001). Longer indwelling time and shorter stricture length were significantly related to success rate. The main complications were stent migration, stent re-stenosis and urinary tract infections. Conclusions: The temporary placement of the AlliumTM BUS showed encouraging results with long-term failure rate of only 25%.展开更多
The authors introduce a new technical modification which facilitates endoscopic resection of urethra tumors located at navicular fossa by using a tipcut condom that covers the resectoscope and the penis. This tech-niq...The authors introduce a new technical modification which facilitates endoscopic resection of urethra tumors located at navicular fossa by using a tipcut condom that covers the resectoscope and the penis. This tech-nique can be used in the diagnosis and management of all kind male anterior urethral lesions at this location.展开更多
The aim of the study was to compare the efficacy of Mathieu combined urethral plate incision(Mathieu-IP)versus onlay island flap urethroplasty in patients with distal hypospadias complicated by urethral stenosis.The c...The aim of the study was to compare the efficacy of Mathieu combined urethral plate incision(Mathieu-IP)versus onlay island flap urethroplasty in patients with distal hypospadias complicated by urethral stenosis.The clinical data of 70 patients with distal hypospadias complicated by urethral plate stenosis treated in the Department of Urology,Anhui Provincial Children’s Hospital(Hefei,China),from May 2019 to May 2022,were retrospectively analyzed.Thirty-eight patients underwent Mathieu-IP(Mathieu-IP group)and 32 underwent onlay island flap urethroplasty(Onlay group).Follow-ups at 1 month,6 months,and 12 months postoperatively assessed operative time,complications,urethral meatus morphology,and family satisfaction.The Mathieu-IP group had significantly shorter operative time(mean±standard deviation[s.d.]:81.58±5.18 min)versus the Onlay group(mean±s.d.:110.75±6.05 min;P<0.05).Surgical success rates were 78.9%(Mathieu-IP group)and 75.0%(Onlay group),with no significant difference(P>0.05).Complications were comparable between the groups.The Mathieu-IP group resulted in a vertical slit-shaped urethral meatus in 89.5%versus 13.8%in the Onlay group(P<0.05).Family satisfaction with general penile appearance and skin shape showed no significant differences,but the Mathieu-IP group had higher satisfaction with meatal position(P<0.05).Mathieu-IP offers simplicity,safety,and shorter operative time compared to Onlay.Both the techniques effectively treat urethral plate stenosis in distal hypospadias,with reduced postoperative complications compared to tubularized incised plate urethroplasty.Mathieu-IP results in a vertical slit-shaped urethral meatus which enhances urinary stream,indicating its potential for broader adoption.展开更多
文摘This study developed an animal model with internal and external urethral sphincter insufficiency by bypassing the sphincter without major damage so that the animal under study can return to normal life after the study.There is a need for a reliable,applicable,and reproducible animal model for studying urinary incontinency disease due to incorrect sphincter function.Seven adult male dogs were used for this study.The urethral sphincter was bypassed by inserting a catheter between the bladder neck and the distal sphincter.The animals'physical condition was closely monitored for 9 weeks,and standard urodynamic and radiologic studies were performed before and 1–2 months after surgery.The animals were killed at 9 weeks after surgery for pathological assessment.Catheter placement caused complete incontinence in the animal,with urodynamic assessments indicating that the animal was unable to control urination and radiological assessments indicating an empty bladder with a residual volume of 50±10 cc.Tissue analysis did not show significant histological damage and inflammation.The study shows that by bypassing the urethral sphincter,which is a reliable and reproducible method,an animal model of urinary incontinence can be developed,which can be used in various studies such as assessing the adequacy of artificial sphincter function.The animals under study did not have any permanent defect,so they were able to return to their normal life.
文摘Objectives:Pelvic fracture urethral injuries(PFUI)result from traumatic disruption of the urethra.A significant proportion of cases are complex rendering their management challenging.We described management strategies for eight different complex PFUI scenarios.Methods:Our centre is a tertiary referral centre for complex PFUI cases.We maintain a prospective database(1995e2016),which we retrospectively analysed.All patients with PFUI managed at our institute were included.Results:Over two decades 1062 cases of PFUI were managed at our institute(521 primary and 541 redo cases).Most redo cases were referred to us from other centres.Redo cases had up to five prior attempts at urethroplasty.We managed complex cases,which included bulbar ischemia,young boys and girls with PFUI,PFUI with double block,concomitant PFUI and iatrogenic anterior urethral strictures.Bulbar ischemia merits substitution urethroplasty,most commonly,using pedicled preputial tube.PFUI in young girls is usually associated with urethrovaginal fistula.Young boys with PFUI commonly have a long gap necessitating trans-abdominal approach.Our success rate with individualised management is 85.60%in primary cases,79.13%in redo cases and 82.40%in cases of bulbar ischemia.Conclusion:The definition of complex PFUI is ever expanding.The best chance of success is at the first attempt.Anastomotic urethroplasty for PFUI should be performed in experienced hands at high volume centres.
文摘Objective:The management of urethral stricture disease depends on the location,length of stricture,and associated urethral pathology.These parameters are obtained from preoperative imaging,with conventional urethrogram(retrograde urethrogram and micturating cystourethrogram[RGU/MCU])being the diagnostic tool of choice despite its many shortcomings.Sono-urethrogram(SUG)is an alternative that addresses most issues of RGU/MCU.Studies comparing RGU/MCU with SUG are limited.With the objective of comparing these two imaging modalities in the evaluation of urethral stricture disease,a prospective study was conducted.Methods:Fifty-six patients suspected of urethral stricture disease on clinical evaluation and confirmed either on RGU/MCU or urethro-cystoscopy were included in the study.SUG was performed by the experienced consultant radiologist who was blinded to the report of RGU/MCU.Findings of RGU/MCU and SUG were compared to intraoperative findings,which served as the reference standard.Results:The median length of the stricture determined intraoperatively was 16.5 mm,by RGU/MCU was 5.8 mm,and by SUG was 13.5 mm.The diagnostic accuracy for determination of the stricture location was 93%for RGU/MCU and 98%for SUG.SUG identified spongiofibrosis in 90%of patients with higher accuracy for the severe degree of spongiofibrosis.Conclusion:SUG has been shown to be more accurate than RGU/MCU in estimating stricture length(both short and intermediate)and localizing the stricture location.Use of SUG in conjunction with RGU/MCU helps in better guidance of stricture management by improving preoperative assessment.Further studies with larger sample sizes are warranted.
文摘Urethral catheterization is an important skill to develop as consultations for“difficult catheterization”are common in practice.Developing a broad approach to difficult urethral catheterization is crucial to improve trainee success rates.Strategies and techniques to improve catheterization success are often passed down and shared between trainees without formal documentation or dissemination of techniques.Herein,we present a framework for difficult urethral catheterization based on clinical history and patient examination,while also providing additional techniques and troubleshooting to overcome common challenges with urethral catheterization in adult and pediatric patients.
文摘We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to permanent severe stress incontinence.In February 2023,he presented with a painless cystic mass in the scrotum.Upon pressing the mass with hand,fluid drained from the external urethral orifice,causing the mass to shrink in size,although it returned to its original size a few hours later.Urography and cystoscopy showed a globular urethral diverticulum located anteriorly.The patient underwent surgical excision of the diverticulum along with urethroplasty.Postoperatively,the urinary stress incontinence persisted,but he declined any further surgical intervention.An artificial urinary sphincter is currently the first-line treatment for male urinary incontinence.However,devices such as penile clamps can serve as an alternative when considering surgical suitability or cost.It is important to note that these devices can lead to serious complications such as urethral erosion,stricture,or diverticulum.Therefore,caution is advised when using such devices,and they should be removed periodically at short intervals.
文摘Background:Bladder augmentation is often necessary to address poorly compliant and low-capacity bladders which can result from Posterior Urethral Valve.Traditional techniques are limited by complications from using bowel tissue,thus in the setting of a megaureter,ureterocystoplasty is favorable.Methods:We present a case of Teapot ureterocystoplasty,which improves vascular protection of the ureter by leaving the distal 3 cm of the ureter tubularized.Cystograms demonstrated bladder capacity improvement from 50 mL to 180 mL post-operatively.Additionally,Creatinine stabilized after a peak of 250 umol/L.Result and Conclusion:This patient is doing well at 4.5-year surveillance and has avoided renal transplant,a common fate for these children.
文摘Lower urinary tract symptoms(LUTS)in women produce significant bother.Common conditions causing LUTS in women include urinary tract infections,overactive bladder,and stress incontinence.Urethral diverticulae and female urethral strictures are rare pathologies.They can cause symptoms,which can mimic commoner conditions,leading to delay in diagnosis and unnecessary delay in treatment.In this article,we discuss in detail the definition,symptoms,epidemiology,pathogenesis,diagnosis,and treatment option for these two conditions.Further understanding of these conditions will aid in the proper diagnosis and prevent delay in management.
基金This work was supported by the National Natural Science Foundation of China(No.81670617).We are very grateful to the CureEdit Company for providing language editing assistance。
文摘The treatment of urethral strictures remains a challenging field in urology even though there are a variety of procedures to treat it at present,as no one approach is superior over another.This paper reviewed the surgical options for the management of different sites and types of anterior urethral stricture,providing a brief discussion of the controversies regarding this issue and suggesting possible future advancements.Among the existing procedures,simple dilation and direct vision internal urethrotomy are more commonly used for short urethral strictures(<1 cm,soft and no previous intervention).Currently,urethroplasty using buccal mucosa or penile skin is the most widely adopted clinical techniques and have proved successful.Nonetheless,complications such as donor site morbidity remain problem.Tissue engineering techniques are considered as a promising solution for urethral reconstruction,but require further investigation,as does stem cell therapy.
文摘Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.
文摘Objective Incidences of post-transurethral resection of the prostate(post-TURP)strictures are between 2.2%and 9.8%.Stricture commonly occurs within the first 6 months.Our objective was to assess the outcomes of patients with obliterative strictures post-TURP that underwent a double-face urethroplasty.Methods This is a single-center prospective study of 17 patients with obliterative proximal bulbar stricture post-TURP who underwent double-face graft urethroplasty by two surgeons between January 2014 and January 2020.We defined post-TURP obliterative strictures as those patients who presented with complete or almost complete obstruction of the urethral lumen and who have had a history of acute urine retention.We have excluded patients with bladder neck contracture.Primary outcome was treatment success,defined as the no need for further treatments.Secondary outcome was post-urethroplasty continent rate.Results Seventeen patients were included in the study with median age of 66(interquartile range 40-77)years;median time of follow-up was 24(interquartile range 12-84)months;median stricture length was 4(interquartile range 2-6)cm.Of the 17 patients,15(88.2%)were successful.All patients were continent after urethroplasty.Conclusion With mid-term follow-up,treatment of obliterative proximal bulbar strictures with double-face buccal mucosa graft is a safe and effective procedure.Obliterative proximal bulbar strictures merit double-face urethroplasty with high-rate success and functional outcomes.
文摘For more than nine decades,transurethral resection of the prostate remains the gold standard for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction.The occurrence of urethral strictures after transurethral resection of the prostate is one of the major late complications and has been reported as the leading cause of iatrogenic urethral strictures in patients older than 45 years who underwent urethroplasty.Although several postulations have been proposed to explain the urethral stricture after transurethral resection of the prostate,the exact etiology of urethral stricture after TURP is still controversial.Suggested etiological factors of urethral stricture formation after transurethral resection of the prostate include infection,mechanical trauma,prolonged indwelling catheter time,use of local anesthesia,and electrical injury by a stray current.One single treatment option is not appropriate for all stricture types.The management of urethral stricture following transurethral resection of the prostate includes minimally invasive endoscopic methods,including urethral dilation and direct visual incision,or open surgical procedures with varying urethroplasty techniques.Although scientific studies focusing on urethral strictures after transurethral resection of the prostate are relatively limited and sparse,we can apply the principles of urethral stricture management before making decisions on individual stricture treatment.
文摘Advances in urogenital plastic surgical tissue transfer techniques have enabled urethral reconstruction surgery to become the new gold-standard for treatment of refractory urethral stricture disease. Questions remain, however, regarding the long-term implications on sexual function after major genital reconstructive surgery. In this article, we review the pathologic features of urethral stricture disease and urologic trauma that may affect erectile function （EF） and assess the impact of various specific contemporary urethroplasty surgical techniques on male sexual function.
文摘The aim of this study was to evaluate erectile function in patients with panurethral stricture after urethral reconstruction. Totally, 65 patients were enrolled. Different urethral reconstructions were performed according to the details of urethral strictures. The erectile function was evaluated before and after surgery. The length and location of stricture and duration from initial diagnosis to operation were recorded. The International Index of Erectile Function-5 （IIEF-5） scores, the quality of life （QoL） scores and the maximal flow rate were obtained before and 3, 6, and 12 months after surgery. A significant improvement in QoL and maximal flow rate was observed 3, 6, and 12 months after surgery compared with those observed before surgery （P 〈 0.05）. An impairment of erectile function was observed in patients with multi-site stricture 3 months after surgery （P 〈 0.05）. Subsequently, these patients recovered 6 and 12 months after surgery. Three months after surgery, the IIEF-5 scores in patients with anterior urethral stricture were higher than those with multi-site stricture. Similar results were observed 6 and 12 months after surgery. No significant difference in age or duration from initial diagnosis to final operation was observed between patients with erectile dysfunction after surgery and patients with normal erectile function. However, a linear regressive relationship was detected between IIEF-5 scores and location of urethral stricture. Surgical reconstruction for treating panurethral strictures has limited effects on erectile function. The location of the stricture, particularly when extended to posterior urethra, was found to be associated with erectile function after surgery.
文摘The recent International Consultation on Urological Disease(ICUD)panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis,as distinct from sphincter stenoses and a urethral disruption injury.Whenever possible,an anastomotic urethroplasty should be performed because of the higher success rate as compared to augmentation urethroplasty.There is some debate currently regarding the critical stricture length at which an anastomotic procedure can be used,but clearly the extent of the spongiofibrosis and individual anatomical factors(the length of the penis and urethra)are important,the limitation for this being extension of dissection beyond the peno-scrotal junction and the subsequent production of chordee.More recently,there has been interest in whether to excise and anastomose or to carry out a stricturotomy and reanastomosis using a Heineke-Miculicz technique.Augmentation urethroplasty has evolved towards the more extensive use of oral mucosa grafts as compared to penile skin flaps,as both flaps and grafts have similar efficacy and certainly the use of either dorsal or ventral positioning seems to provide comparable results.It is important that the reconstructive surgeon is well versed in the full range of available repair techniques,as no single method is suitable for all cases and will enable the management of any unexpected anatomical findings discovered intra-operatively.
基金supported by the Natural Science Foundation of Shaanxi Province(No.SJ08-ZT09)
文摘Objective To assess the therapeutic efficiency of short anterior urethral stricture treated with endourethral surgery combined with iridium 192 radiation therapy in order to decrease the recurrence rate after endourethral surgery.Methods A total of 286 patients with anterior urethral stricture(stricture length ranging from 0.5 to 2.5 cm,averaging at 1.6 cm)were divided randomly into two groups after internal urethrotomy and cicatrix electrotomy.The radiation group of 173 patients was treated as soon as possible with iridium 192 radiation therapy on the stricture sections while the control group of 113 patients was not.The recurrence rate was compared between the two groups during one year’s follow-up.Results Among all the 286 successful operations,stricture recurred in 19 patients of the radiation group(recurrence rate of 10.98%)and in 62 ones of the control group(recurrence rate of 54.86%),with a significant difference(P=0.003).Conclusion It is an effective way to prevent recurrence by treating patients as early as possible with iridium 192 radiation on the stricture sections after endourethral operation on anterior urethral stricture.
文摘Objective:To investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate(TURP)and correlate its incidence with intra-operative urethral mucosal injury during TURP.Also to compare the other established risk factors affecting the development of urethral stricture among patients undergoing monopolar or bipolar TURP over a period of 6 months follow-up as the prospective randomized study.Methods:One hundred and fifty men older than 50 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo either standard monopolar TURP with glycine as the irrigation fluid or bipolar TURP with normal saline as irrigant.The prostate size,operative time,intra-operative mucosal rupture,catheter time,catheter traction duration,uroflowmetry,and post-operative stricture rate were compared.Results:A total of 150 patients underwent TURP,including 74 patients undergoing monopolar TURP(one patient was excluded as his post-operative histopathological examination report was of adenocarcinoma prostate)and 75 patients undergoing bipolar-TURP,all of which were performed using a 26 Fr sheath resectoscope.The mean International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 months and 6 months were comparable between the groups.Out of 149 patients,nine patients(6.0%)developed urethral stricture.The severity of the injury(urethral mucosal injury)correlated with the likelihood of developing a subsequent complication(stricture urethra).Patients with stricture had significantly larger prostate volume than patients without stricture(65.0 mL vs.50.0 mL;p=0.030).Patients with stricture had longer operative time than patients without stricture(55.0 min vs.40.0 min;p=0.002).In both procedures,formation of post-operative stricture urethra was independently associated with intra-operative mucosal injury.Conclusion:Intra-operative recognition of urethral mucosal injury helps in prediction of stricture urethra formation in early post-operative period.
文摘AIM： To analyze the clinical features, diagnostic modalities, and the surgical management of urethral complications after tension-free vaginal tape procedures.METHODS： This study encompasses a retrospective review of nine patients presented with urethral complic-ations after midurethral sling procedures. The patients underwent the procedures during a period from 1999 to 2012 in three different regional hospitals in the southwest part of Sweden. The time from sling placement to diagnosis, the risk factors, clinical features, diagnosis, surgical management, and functional outcome are presented. The presenting symptoms were described as either early onset （〈 12 mo） or late onset （〉 12 mo） according to when they were frst reported.RESulTS： Eight cases of urethral erosion and one case of bladder-neck erosion were detected. The mean interval for diagnoses of the erosions ranged from 3 mo to 11 years. The most common presenting symptoms included de novo urgency with or without incontinence （7/9 patients）, urinary retention/voiding dysfunction （4/9 patients）, urethritis （4/9 patients）, relapse of stress-incontinence （3/9 patients）, recurrent urinary tract infections （5/9 patients）, and hematuria （1/9 patient）. In most cases, voiding dysfunction and urethritis occurred early after the operation. The surgical management applied in most cases was transurethral resection of the intraurethral part of the mesh. The removal of the intraurethral mesh resulted in improvement or complete cure of urgency symptoms in 5/7 patients with urgency. Four patients were reoperated with a new stress-incontinence surgery, one with laparoscopic Burch, and three with retropubic tension-free vaginal tape procedures. COnCluSIOn： Urethral complications should be suspected in the case of de novo urgency and relapse of stress-incontinence. Transurethral excision of the intraurethral mesh is the recommended treatment.
文摘Objectives: To report the 2-years follow-up of patients with bulbar urethral strictures treated with the new AlliumTM Bulbar Urethral Stent (Allium BUS). Methods: The stent is a fully covered, self-expendable, large caliber metal stent specially designed for the treatment of bulbar urethral strictures. The stent is comprised of a coiled super-elastic structure covered by a polymeric coating designed to prevent mucosal hyperplasia. The indwelling time is 12 months, after which the stent should have been removed. Sixty-four patients with recurrent bulbar stricture were treated with Allium BUS in 3 worldwide centers. Results: All stents were successfully inserted with no perioperative complications. In a median follow-up of 25.5 months, the mean maximal flow rate following stent insertion was significantly higher compared to the pre-surgical flow rate (14 ml/sec vs 6.6 ml/sec, p < 0.0001). Longer indwelling time and shorter stricture length were significantly related to success rate. The main complications were stent migration, stent re-stenosis and urinary tract infections. Conclusions: The temporary placement of the AlliumTM BUS showed encouraging results with long-term failure rate of only 25%.
文摘The authors introduce a new technical modification which facilitates endoscopic resection of urethra tumors located at navicular fossa by using a tipcut condom that covers the resectoscope and the penis. This tech-nique can be used in the diagnosis and management of all kind male anterior urethral lesions at this location.
文摘The aim of the study was to compare the efficacy of Mathieu combined urethral plate incision(Mathieu-IP)versus onlay island flap urethroplasty in patients with distal hypospadias complicated by urethral stenosis.The clinical data of 70 patients with distal hypospadias complicated by urethral plate stenosis treated in the Department of Urology,Anhui Provincial Children’s Hospital(Hefei,China),from May 2019 to May 2022,were retrospectively analyzed.Thirty-eight patients underwent Mathieu-IP(Mathieu-IP group)and 32 underwent onlay island flap urethroplasty(Onlay group).Follow-ups at 1 month,6 months,and 12 months postoperatively assessed operative time,complications,urethral meatus morphology,and family satisfaction.The Mathieu-IP group had significantly shorter operative time(mean±standard deviation[s.d.]:81.58±5.18 min)versus the Onlay group(mean±s.d.:110.75±6.05 min;P<0.05).Surgical success rates were 78.9%(Mathieu-IP group)and 75.0%(Onlay group),with no significant difference(P>0.05).Complications were comparable between the groups.The Mathieu-IP group resulted in a vertical slit-shaped urethral meatus in 89.5%versus 13.8%in the Onlay group(P<0.05).Family satisfaction with general penile appearance and skin shape showed no significant differences,but the Mathieu-IP group had higher satisfaction with meatal position(P<0.05).Mathieu-IP offers simplicity,safety,and shorter operative time compared to Onlay.Both the techniques effectively treat urethral plate stenosis in distal hypospadias,with reduced postoperative complications compared to tubularized incised plate urethroplasty.Mathieu-IP results in a vertical slit-shaped urethral meatus which enhances urinary stream,indicating its potential for broader adoption.
